Provider Demographics
NPI:1104297092
Name:WALKER, SHANDA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 FM 346 E
Mailing Address - Street 2:NONE
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-8133
Mailing Address - Country:US
Mailing Address - Phone:214-683-4420
Mailing Address - Fax:
Practice Address - Street 1:401 E FRONT ST
Practice Address - Street 2:SUITE 123
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8213
Practice Address - Country:US
Practice Address - Phone:903-531-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist